Autism and BPD may be mistaken for each other as both can feature low cognitive empathy and relationship difficulties.
Autism spectrum disorder (ASD) and borderline personality disorder (BPD) are two conditions that, at first glance, might seem to have very little in common: ASD is a neurodevelopmental disorder that’s mostly diagnosed in males, while BPD is a personality disorder primarily diagnosed in females.
But for quite some time now, researchers have noticed some overlap between the two conditions. This symptom overlap has resulted in some misdiagnoses, especially in autistic individuals without intellectual disabilities.
Autism spectrum disorder (ASD) and borderline personality disorder (BPD) may share several features — including an imbalance in the different types of empathy and challenges with interpersonal skills — which can lead to a misdiagnosis in some cases.
In particular, autistic individuals without any clear intellectual disabilities may be at risk of being misdiagnosed with a personality disorder.
In a 2022 study of 161 participants who received a late ASD diagnosis in adulthood, nearly 15% (24) had previously been diagnosed with a personality disorder.
Of these, most had been diagnosed with personality disorder not otherwise specified, while 4 people had been diagnosed with BPD.
The study authors conclude that the presence of co-occurring non-suicidal self-harm, depression, and ADHD, as well as a lack of autism knowledge in primary care, may contribute to the risk that autism may be misdiagnosed as a personality disorder.
Autism is a neurodevelopmental disorder characterized by social and communication difficulties, alongside unusually strong, narrow interests or unusually repetitive or restrictive behaviors.
It occurs in about 1.5% of the general population and is more commonly diagnosed in males.
ASD symptoms vary widely from person to person. Social problems in ASD can occur due to difficulties with:
- integrating communication styles
- making eye contact
- understanding and using social cues
In contrast, BPD is a personality disorder marked by emotional intensity/dysregulation and difficulties in interpersonal functioning, empathy, trust, and intimacy. People with BPD also tend to have the personality traits of disinhibition, antagonism, and impulsivity.
The emotions of people with BPD are often intense and long-lived making it more difficult to establish emotional stability. BPD has a lifetime prevalence of
When diagnostic confusion between ASD and BPD occurs, it is likely related to the fact that both people with ASD and BPD may show lower levels of cognitive empathy (the ability to understand and respond to other people’s emotions) and poor interpersonal skills.
In BPD, however, low cognitive empathy is often due to a lack of emotional regulation, and therapeutic interventions tend to help.
Both ASD and BPD may also involve executive dysfunction (behavioral symptoms that interfere with your ability to manage your own thoughts, feelings, and actions).
Both disorders also feature impairment in social and occupational functioning — although, in BPD, this tends to lessen over time.
People with either disorder are also more likely to self-harm. In autism, this is sometimes due to
The researchers found no major differences in the following traits:
- social avoidance
- restricted expressiveness
The following traits were stronger in BPD than in ASD:
- openness to experience
- emotional dysregulation
- dissocial behavior
But the following traits were more prominent in ASD:
ASD and BPD can co-occur and can sometimes be identified by certain features.
In a questionnaire study of 474 college students, researchers sought to identify the co-occurrence of autistic and borderline personality disorder traits in a non-clinical sample of young adults.
The findings show that 17% had both high autistic and BPD traits, which were weakly correlated. Those with symptoms of both disorders also had higher levels of suicidal ideation than the BPD group alone, despite similar levels of depression.
The authors suggest that the higher suicidality seen in people with comorbid ASD and BPD may extend to non-clinical individuals with high levels of co-occurring autistic and BPD traits.
ASD and BPD are two disorders that seem to have very little in common, but researchers have noticed some overlap between the two conditions.
Both autism and BPD have the following features:
- reduced cognitive empathy
- poor interpersonal skills
- executive dysfunction
And when the disorders are seen together, suicide risk and negative self-image become stronger. Self-harm may also be present in both conditions.
If you have any of these symptoms and think you may have been misdiagnosed, be sure to reach out to a trusted mental health professional to discuss your symptoms. Having the right diagnosis is the first step on your way to well-being.